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Modified Hysto Waiver

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Hi all,

I thought I'd share with you my version of my hysterectomy waiver I

gave my surgeon prior to my myo. I decided to give just a little

wiggle room, because, when I originally said 'absolutely no hysto' to

my surgeon, he said " Well, I may have to leave one in, if it is close

to a blood supply " . The more I thought about it, the more I wanted

to sanely make sure all the buggers were taken out, know that my NEXT

surgery, if needed, will be a hysterectomy anyway. So here's my

version:

* * * * * * *

HYSTERECTOMY WAIVER

I am consenting to a myomectomy by Dr.X. I want every possible

measure taken to remove all fibroids, especially those which, in Dr.

X's experience, are most certain to grow bigger and necessitate

another surgery.

I want every possible measure taken to prevent the removal of my

uterus. I would like the thorough removal of my fibroids to be

balanced with my desire to keep my uterus. I would like Dr. X to

take all measures possible to avoid excessive bleeding.

I do not want my ovaries or cervix removed under any circumstances,

except to save my life or to save a vital organ, such as liver,

kidney, etc.

_____________________ _____________________

Your Name Date:

- - - - - -

I have read and understand this document, and will do my best to

abide by the patient's wishes. A copy of this document will be

placed in her hospital chart.

___________________________________

Dr. X

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